Provider Demographics
NPI:1639863020
Name:HESKETT, LAUREL (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREL
Middle Name:
Last Name:HESKETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-2427
Mailing Address - Country:US
Mailing Address - Phone:402-672-0366
Mailing Address - Fax:
Practice Address - Street 1:505 W SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1705
Practice Address - Country:US
Practice Address - Phone:712-246-1786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA120378152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist